Pulmonary vascular disease Flashcards
What are the different types of pulmonary vascular disease?
6
(1) Congestion
(2) Edema
(3) Embolism
(4) Infarct
(5) Hypertension
(6) Diffuse alveolar damage
What are the causes of pulmonary embolism?
6
(1) Thromboembolism
(2) Bone marrow/fat embolism
(3) Air embolism
(4) Amniotic fluid embolism
(5) Talc embolism
(6) Tumor embolism
What are the complications of pulmonary embolism?
(1) Sudden death
(2) Ventilation-perfusion imbalance
(3) Acute right heart failure
(4) Pulmonary hypertension
(5) Pulmonary infarct
What is the cause of pulmonary infarction?
Pulmonary artery occlusion plus underlying heart or lung disease
What is the pathology of pulmonary infarction?
3
(1) Typically peripheral wedge-shaped lesion
(2) Coagulative necrosis
(3) Hemorrhagic
What are the risk factors for deep venous thrombosis?
5
(1) Tissue damage from fractures, trauma, and burns
(2) Venous stasis
(3) Malignancy
(4) Pregnancy, oral contraceptives
(5) Deficiency of anti-coagulants
What is pulmonary hypertension?
Pulmonary pressure greater than 1/4 of systemic pressure
What are the causes of pulmonary hypertension?
4
(1) COPD/ILD
(2) Heart disease
(3) Recurrent thromboemboli
(4) Idiopathic
What is the pathology of pulmonary hypertension?
4
(1) Small arteries and arterioles most affected
(2) Increased thickness of media
(3) Intimal fibrosis
(4) Atheromatous formation in severe pulmonary hypertension
What distinguishes end-stage pulmonary hypertension?
Plexiform lesions of pulmonary arteries
What are some causes of diffuse alveolar damage?
6
(1) Infection, especially from viral pneumonia
(2) Chemical toxins
(3) Drug reaction or narcotic overdose
(4) Trauma with shock
(5) Post-cardiopulmonary bypass
(6) Hypersensitivity
(6) Septicemia
What is a histological sign of diffuse alveolar damage?
Hyaline membrane formation
What is severe acute respiratory syndrome (SARS)?
Infiltrative lung disease caused by coronavirus
What are symptoms of pulmonary embolism?
7
Overall gradual onset
(1) Dyspnea (sudden onset)
(2) Pleuritic chest pain
(3) Cough
(4) Palpitations
(5) Hemoptysis
(6) Syncope
(7) Leg pain/swelling
What are the signs of pulmonary embolism?
7
(1) Tachypnea (RR>20)
(2) Tachycardia (HR>100)
(3) Fever
(4) Accentuated second heart sound (S2)
(5) Signs of DVT (peripheral edema)
(6) Rales/wheezing
(7) Raised jugular venous pressure
What is Virchow’s Triad?
Virchow’s Triad is risk factors for pulmonary embolism:
1) Venous stasis (from immobility or cardiac dysfunction
(2) Vascular injury
(3) Hypercoagulability
How is pulmonary embolism diagnosed?
12
(1) Chest x-ray:
(a) normal
(b) atelectasis
(c) pleural effusion
(d) Hampton’s Hump
(2) ECG:
(a) sinus tachycardia
(3) D-Dimer negative
(4) ABG:
(a) respiratory alkalosis
(b) hypoxemia
(c) increased A-a gradient
How is pulmonary embolism treated?
3
(1) Anticoagulation - heparin, warfarin, or factor Xa inhibitor
(2) IVC filter placement - prevents clots from embolizing (useful in patients who can’t be anticoagulated)
(3) Thrombolysis - tPA, indicated for shock due to PE
How is pulmonary hypertension diagnosed?
4
(1) Chest x-ray
(2) ECG - signs of right ventricular hypertrophy and strain
(3) Echocardiogram - right side of heart enlarged
(4) Right-heart catheterization
How is pulmonary hypertension treated?
6
Basic therapy:
(1) Diuretics for fluid retention
(2) Oxygen for hypoxemia
(3) Anticoagulation
Others:
(4) Calcium channel blockers
(5) Chronic thromboembolic pulmonary hypertension treated by riociguat
(6) Lung or heart/lung transplant
In which disease will a loud second heart sound be heard?
Pulmonary embolism
What determines movement of fluid out of pulmonary capillaries and into the interstitial space?
(3)
(1) Hydrostatic pressure in pulmonary vessels and interstitium
(2) Colloid osmotic pressure
(3) Permeability of endothelium
What determines movement of fluid out of pulmonary interstitium and into alveolar space?
(1) Substantial increase in fluid movement into interstitium
(2) Impeded lymphatic drainage
(3) Damage to alveolar epithelium
What are the stages of pulmonary edema?
3
(1) Stage I: eccentric accumulation of fluid in interstitial space
(2) Stage II: crescentic filling of alveoli when formation of edema fluid exceeds removal
(3) Stage III: alveolar flooding, occuring heterogeneously
What are the characteristics of cardiogenic pulmonary edema?
(1) Hydrostatic pressure within pulmonary capillaries is increased due to increased left ventricular/atrial pressure
(2) Permeability barrier still intact
(3) Fluid that leaks out has low protein content
(4) Can be caused by left heart failure and mitral stenosis
What are the characteristics of non-cardiogenic pulmonary edema?
(1) Normal hydrostatic pressure
(2) Increased permeability of capillary endothelial and alveolar epithelial barrier
(3) Fluid has high protein content because proteins move out of intravascular space
(4) Can be caused by sepsis, chemical or gas injury
What are the clinical conditions associated with the development of ARDS?
Direct lung injury (3)
Indirect lung injury (4)
(7 total)
Direct lung injury:
(1) Pneumonia
(2) Aspiration of gastric content
(3) Inhalation injury
Indirect lung injury:
(4) Sepsis
(5) Severe trauma
(6) Acute pancreatitis
(7) Drugs
What are the diagnostic criteria for ARDS?
5
(1) Nonspecific result of acute injury to the lung
(2) Acute onset
(3) Bilateral opacities not fully explained by effusions, lung collapse, or nodules
(4) Respiratory failure not fully explained by heart failure or volume overload
(5) Impaired oxygen
What is the pathology of ARDS?
Diffuse alveolar damage
What are the causes of multiple organ dysfunction syndrome?
6
(1) Renal dysfunction
(2) Hepatobiliary dysfunction
(3) CNS dysfunction
(4) GI dysfunction
(5) CV dysfunction
(6) Hematologic dysfunction
What are the diagnostic criteria for ARDS?
3
(1) Pulmonary artery wedge pressure not elevated (heart not the cause)
(2) Lung compliance is reduced (ΔV/ΔP)
(3) Severe hypoxia:
PaO2/FiO2 200)
Why does hypoxia occur in ARDS?
Shunting due to mismatched perfusion-ventilation
How is ARDS treated?
2
Supportive care:
(1) “Lung protective” vent management - positive pressure ventilation opens formerly closed small airways, decreasing shunt and increasing oxygenation
(2) Treat underlying disease
